EmailMeForm
Application for Admission
Application Deadline: December 13, 2019
You may "Save and Resume" to complete application within 30 days of starting. Upon completion of online application, you will be redirected to pay the $150 application fee.
Legal Name
*
First
Middle
Last
Date of Birth
*
MM
/
DD
/
YYYY
Upload Current Photo
Hebrew Name
Called by name
*
This application is for enrollment as:
*
Grade 9
Transfer Student
Transfer into Grade:
*
Please select
9
10
11
12
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone
*
###
-
###
-
####
Student Cell Phone
###
-
###
-
####
Student Email
EDUCATION
Please list current school first, followed by any previous schools
School
School Address
School Phone
Grade(s) Attended
Current School
Previous School
Previous School
Email Address of Current School Principal (or similar administrator) to whom to send an applicant evaluation form
Has the applicant ever had an educational evaluation or does the applicant have a 504 Plan?
Yes
No
Date of Most Recent Evaluation
MM
/
YYYY
Please Upload a Copy of Your Most Recent IEP or 504 Plan.
Received resource help?
Yes
No
If so, in what areas?
Been diagnosed with a learning disability
Yes
No
Please explain
Please indicate the Math course you are currently taking
*
Pre-Algebra (8th Grade Math)
Algebra (Honors Math)
Other
Please indicate the High School Math course you are currently taking
*
Algebra 1
Geometry
Algebra 2
EXTRA-CURRICULAR
Please list your special interests, hobbies, extra-curricular and chessed activities:
How have you spent the last 3 summers? How do you plan to spend next summer?
What youth groups are you involved in?
FAMILY INFORMATION
Primary Custodian
*
Both Parents
Mother
Father
Parents' Marital Status
*
Married
Divorced
Separated
Deceased Parent
Single
Father's Information
Father's Name
*
Prefix
First
Last
Please include Title i.e. Mr., Dr., Rabbi, etc in Prefix field
Father Cell Phone
###
-
###
-
####
Father Email
*
Occupation
Employer
Business Phone
###
-
###
-
####
Education (last degree received and institution)
Father Address if different from primary address listed above
Street Address
City
State / Province / Region
Postal / Zip Code
Mother's Information
Mother's Name
*
Prefix
First
Last
Please include Title i.e. Mrs., Dr., etc in Prefix field
Mother Cell Phone
###
-
###
-
####
Mother Email
*
Occupation
Employer
Business Phone
###
-
###
-
####
Education (last degree received and institution)
Mother Address if different from primary address listed above
Street Address
City
State / Province / Region
Postal / Zip Code
SIBLINGS
Name
Current School / Occupation
Grade
Ma'ayanot Student or Alumna?
GENERAL INFORMATION
Synagogue Affiliation
Name of Rabbi
Language(s) Spoken at Home
Special Circumstances
Family Illness
Conversion
Adoption
Other
Please explain:
Past / Current restrictive conditions or illness of applicant
STUDENT INTERVIEW
Students are requested to come to Ma'ayanot for an interview, accompanied by one or both parents. Interviews usually last about 45 minutes.
Who should we contact to schedule a student interview?
*
What is the best way to contact you?
Cell Phone
Home Phone
Email
Preferred Interview Day (may check multiple)
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Interview Time (multiple ok)
8:30 AM - 10:30 AM
10:30 AM - 1:30 PM
1:30 PM - 4:00 PM
ESSAY QUESTIONS
Please answer the two questions below so we can get to know you better!
Essay # 1
Describe one of your personal qualities
Suggested length, 1- 2 paragraphs
Essay # 2
Describe a goal you would like to accomplish in your four years of high school
Suggested length, 1-2 sentences
